Cited by 131LGBTQ Health, Identity, and PolicyRacial and Ethnic Identity ResearchAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

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Minority stressors and psychological distress in transgender individuals.

Timmins, Liadh, Rimes, Katharine A., Rahman, Qazi·2017·Psychology of Sexual Orientation and Gender Diversity

DOI 10.1037/sgd0000237

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Abstract

This study tested direct and indirect associations between minority stressors and psychological distress in a large, geographically diverse sample of transgender individuals (N = 1,207). Transgender individuals were recruited for an online, cross-sectional survey using targeted sampling. Structural equation modeling was used to test the hypothesized model, which was based on Hatzenbuehler's (2009) integrative mediation framework. Expectations of rejection, self-stigma, and prejudice events were all associated with psychological distress, and these relationships were partially accounted for by rumination. This model had good fit (Tucker-Lewis Index =.96, Comparative Fit Index =.98, Root Mean Square Error of Approximation =.05, 90% CI [.05,.06]) and explained 54.5% of the variance in psychological distress and 29.3% in rumination. This is the first study to examine a model of minority stress and psychological distress that includes rumination and all four minority stressors from Meyer's (2003) framework in a large sample of transgender individuals. Results indicate a strong relationship between minority stressors and psychological distress among transgender people, and that these relationships are partially explained by rumination. Results need to be considered in relation to the cross-sectional nature of the design and the possible role for additional variables. Future research should investigate these findings using designs that provide tests of causality.

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Background
Is Being Queer Gay? Sexual Attraction Patterns, Minority Stressors, and Psychological Distress in Non-Traditional Categories of Sexual Orientation
Timmins, L., Rimes, K. A., & Rahman, Q. (2020) · The Journal of Sex Research · doi:10.1080/00224499.2020.1849527 · Cited by 18
“Participants consisted of cisgender pansexual (n = 160), queer (n = 80), asexual (n = 98), heterosexual (n = 1,021), bisexual (n = 1,518), and lesbian/gay (n = 2,730) individuals, drawn from a previous online survey study (Timmins et al., 2017, 2020).”
BackgroundMethodInfluentialSelf-citation
The impact of transgender minority stress and emotion regulation on suicidality and self-harm
Drescher, C. F., Kassing, F., Mahajan, A., & Stepleman, L. M. (2023) · Psychology and Sexuality · doi:10.1080/19419899.2023.2164867 · Cited by 18
“Like MST, this psychological mediation framework was initially developed with sexual minoritized individuals in mind, but has since been applied to TGD individuals (e.g. Timmins et al., 2017).”
Method
Mapping key stakeholders’ position towards interdisciplinary transgender healthcare: A stakeholder analysis
Nieder, T. O., Koehler, A., Briken, P., & Eyssel, J. (2019) · Health & Social Care in the Community · doi:10.1111/hsc.12870 · Cited by 13
The impact of psychological flexibility in the relationship between discrimination and internalized transnegativity among transgender and gender expansive adults
Igarashi, Y., Staples, J., Vigil, S., Pero, G., Gardner, R., Thomat, A., & Abascal, L. (2022) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2022.03.005 · Cited by 12
Mental health treatment experiences among sexual and gender minority individuals: Trauma exposure, barriers, microaggressions, and treatment satisfaction
Artime, T. M., Rosenfeld, E. A., Ong, L. E., Lisha, N. E., Dilley, J., Shumway, M., Edward, D., Ceja, A., Einhorn, L., Lubensky, M. E., et al. (2024) · Journal of Gay & Lesbian Mental Health · doi:10.1080/19359705.2024.2315976 · Cited by 13
“…exposure to events that meet Criterion A (exposure to or witnessing death, threat of death, serious injury, or sexual violence) for PTSD (APA, 2013), SGM individuals report pervasive experiences of minority stress (Green et al., 2022; Meyer, 2003; Puckett et al., 2016; Timmins et al., 2017).”
COVID-19 stressors and symptoms of depression and anxiety among Black cisgender sexual minority men and Black transgender women during the initial peak of the COVID-19 pandemic
Timmins, L., Schneider, J. A., Chen, Y., Pagkas-Bather, J., Kim, B., Moody, R. L., Al‐Ajlouni, Y. A., Lee, F. L. F., Koli, K., Durrell, M., et al. (2022) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-022-02282-2 · Cited by 12
“With regards to sexual and gender minorities (SGM), these groups are well-established as having higher rates of a range of mental health issues than cisgender, heterosexual populations [16–18] likely due to increased general and SGM-specific stressors [19, 20], and these disparities have been shown to persist during t…”
BackgroundSelf-citation
Longitudinal Outcomes of Gender Identity in Children (LOGIC): protocol for a prospective longitudinal cohort study of children referred to the UK gender identity development service
Kennedy, E., Spinner, L., Lane, C., Stynes, H., Ranieri, V. F., Carmichael, P., Omar, R., Vickerstaff, V., Hunter, R. M., Wright, T., et al. (2021) · BMJ Open · doi:10.1136/bmjopen-2020-045628 · Cited by 11
Desire for Genital Surgery in Trans Masculine Individuals: The Role of Internalized Transphobia, Transnormativity and Trans Positive Identity
Anzani, A., Biella, M., Scandurra, C., & Prunas, A. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19158916 · Cited by 13
“The model we tested can be embedded within the gender minority stress theory [3,37].”
Method
The Effects of Cyberbullying and Non-consensual Sexting on Gender Minority Stress and Psychological Functioning in Transgender Adults
Mussap, A. J., Clancy, E. M., & Klettke, B. (2023) · Journal of LGBTQ Issues in Counseling · doi:10.1080/26924951.2023.2227020 · Cited by 10
Discrimination, gender dysphoria, drinking to cope, and alcohol harms in the UK trans and non-binary community
Davies, E., Ezquerra-Romano, I., Thayne, B., Holloway, Z., Bayliss, J., O’Callaghan, S., & Connolly, D. J. (2023) · Alcohol and Alcoholism · doi:10.1093/alcalc/agad060 · Cited by 11
Associations between Microaggression and Adjustment Outcomes: A Meta-Analytic and Narrative ReviewPreprint
Lui, P. P., & Quezada, L. (2018) · OSF Preprints (OSF Preprints) · doi:10.31219/osf.io/xj8n3 · Cited by 10
Issues in Working with Transgender Individuals Who Sexually Harm
Jumper, S. A. (2021) · Current Psychiatry Reports · doi:10.1007/s11920-021-01251-x · Cited by 8
Differential associations between enacted and expected stigma with psychological distress, alcohol use, and substance use in transgender and gender diverse people
Puckett, J. A., Veldhuis, C. B., Gilbert, P. A., Anderson‐Carpenter, K. D., Mustanski, B. S., & Newcomb, M. E. (2023) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2023.109921 · Cited by 10
Healthcare discrimination and treatment adherence among sexual and gender minority individuals living with chronic illness: the mediating effects of anticipated discrimination and depressive symptoms
Brooks, B. D., Job, S. A., Kaniuka, A. R., Kolb, R., Charvel, P. U., & Araújo, F. (2023) · Psychology and Health · doi:10.1080/08870446.2023.2220008 · Cited by 8
“The PHQ-9 has demonstrated good to excellent internal consistency among SGM samples (Bariola et al., 2017; Brooks et al., 2022a; Kaniuka et al., 2021; Nguyen et al., 2016; Timmins et al., 2017).”
Emotion Regulation Differences Between Gender and Sexuality Groups: A Systematic Review and Meta-Analysis
Camp, J., Blundell, E., Smith, P. A., & Rimes, K. A. (2025) · Archives of Sexual Behavior · doi:10.1007/s10508-025-03276-2 · Cited by 7
“…future research should examine emotion regulation processes that were either underrepresented or absent in this review, such as problem solving as an emotion regulation strategy and rumination, given their potential importance (Borders et al., 2014; Gross, 2015a, 2015b; Timmins et al., 2017).”
Self-citation
Transgender and Gender Diverse Patients in Intensive Mood Disorder Treatment: A Comparative Examination of Clinical Presentation and Treatment Outcomes
Pinciotti, C. M., Wadsworth, L. P., Miron, L. R., Riemann, B. C., & Leonard, R. C. (2022) · Behavior Therapy · doi:10.1016/j.beth.2022.05.004 · Cited by 7
The Impact of Psychological Distress on the Occupational Well-Being of Sexual and Gender Minorities
Pereira, H., Silva, P., & Beatriz, C. D. (2022) · Healthcare · doi:10.3390/healthcare10040699 · Cited by 7
Internalized Homophobia and Transphobia
McLean, L. L. (2020) · Springer eBooks · doi:10.1007/978-3-030-52612-2_3 · Cited by 6
Sleep and Its Disorders Among Sexual and Gender Minority Populations
Martin‐Storey, A., Legault, R., & Prickett, K. C. (2020) · Current clinical neurology · doi:10.1007/978-3-030-40842-8_7 · Cited by 6
Développer la résilience chez les jeunes trans et non binaires : un modèle basé sur l’éthique de la reconnaissance d’Axel Honneth
Médico, D. (2021) · International Journal of Child and Adolescent Resilience · doi:10.7202/1082073ar · Cited by 8
Mental Health Literacy Among Individuals with Gender Dysphoria and Its Correlations with Satisfaction of Basic Psychological Needs: A Cross-Sectional Study in Northwest of Iran
Shafiee‐Kandjani, A. R., Azarmi, L., Shalchi, B., Malek, A., Esmaeili, E. D., & Turan, Ş. (2025) · Transgender Health · doi:10.1089/trgh.2024.0172 · Cited by 5
Unfolding the layers of LGBTQ+ identity, resilience, and multicultural perspectives in Vietnam
Lam-Nguyen, H. (2025) · Frontiers in Sociology · doi:10.3389/fsoc.2025.1536046 · Cited by 5
We are Just People: Transgender Individuals’ Experiences of a Local Equal Rights Debate
Robertson, D. L., Pow, A. M., Hunt, D., Hudson, B., & Mickelsen, R. (2019) · Journal of LGBTQ Issues in Counseling · doi:10.1080/15538605.2019.1627974 · Cited by 5
“Numerous direct experiences with prejudice constitute a chronic minority stressor for transgender people (Timmins et al., 2017).”
BackgroundResult
Development and Initial Validation of Scales for Coming Out Vigilance and Positive Coming Out Responses
Skidmore, S. J., Lefevor, G. T., Huynh, K. D., & Berg, C. O. (2023) · Sexuality & Culture · doi:10.1007/s12119-023-10144-5 · Cited by 6
“This qualitative study was the first to provide a specific list of affirmative responses to coming out; these responses coincide with findings that SGMs tend to report higher well-being when they are responded to with affirmation, validation, and understanding (Perrin-Wallqvist & Lindblom, 2015).”
Influential
Characteristics of non-suicidal self-injury and its associations with gender minority stressors among Hungarian transgender and gender diverse adults
Ünsal, B. C., Demetrovics, Z., & Reinhardt, M. (2025) · BMC Psychiatry · doi:10.1186/s12888-025-06738-y · Cited by 6
Gender Minority Stressors, Hopelessness, and Their Associations with Internalizing and Externalizing Mental Health Outcomes in a Hungarian Trans Adult Sample
Ünsal, B. C., Demetrovics, Z., & Reinhardt, M. (2025) · Archives of Sexual Behavior · doi:10.1007/s10508-025-03147-w · Cited by 4
“The psychological mediation framework has been tested in trans populations previously by including rumination (Timmins et al., 2017), resilient coping (Logie et al., 2020), and shame (Scandurra et al., 2018) as mediators and was shown to be a valid framework for explaining the mental health of…”
Sleep health among youth outside of the gender binary: Findings from a national Canadian sample
Martin‐Storey, A., Mayne, K., Beischel, W. J., & Craig, W. (2024) · Sleep Health · doi:10.1016/j.sleh.2024.07.010 · Cited by 4
Psychosocial influences on pain in transgender individuals
Clemens, K. S., Matkovic, J., Odelson, A., Strain, A., & Wesselmann, E. D. (2025) · Frontiers in Pain Research · doi:10.3389/fpain.2025.1546526 · Cited by 3
The Experiences of Transgender and Gender Diverse Individuals Seeking Mental Health Treatment: A Qualitative Exploratory Study
Marks, B., Salpietro, L., & Terrell, K. R. (2025) · Journal of LGBTQ Issues in Counseling · doi:10.1080/26924951.2025.2510342 · Cited by 3
Internalized transphobia and psychological distress among transgender and gender non-confirming emerging adults: The mediating roles of social support and gender identity disclosure
Hong, C., Mammadli, T., Wu, E. S. C., & Holloway, I. W. (2025) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2025.09.075 · Cited by 3
The impact of gender identity change efforts on generalized anxiety, social anxiety, and appearance anxiety among transgender and gender diverse individuals: Investigating general and group-specific psychological processes
Chan, R. C. H., & Lam, M. S. (2026) · International Journal of Transgender Health · doi:10.1080/26895269.2026.2628317 · Cited by 3
Understanding How Coming Out Goes Well for Sexual and Gender Minorities
Skidmore, S. J., & Lefevor, G. T. (2024) · Journal of Homosexuality · doi:10.1080/00918369.2024.2420072 · Cited by 3
“…SGMs in uncertain social environments may experience heightened stress and anxiety as they contemplate coming out (Keating & Muller, 2020; Timmins et al., 2017), with some ultimately opting to maintain secrecy regarding their SGM identity (Duncan et al., 2019), further highlighting the…”
Assessing Patient Goals for Gender-Affirming Hormone Therapy: A Standardized Patient Case for Medical Students
Spigner, S. T., Rivera, N. V., Ufomata, E. O., Mark, E. G., Grieve, V. L. B., Faeder, M., Fulmer, V. L., Deusen, R. V., Gowl, C., Hofkosh, D., et al. (2023) · MedEdPORTAL · doi:10.15766/mep_2374-8265.11356 · Cited by 3
Self-Compassion Contributes to Decreased Hopelessness in Young Gay Men: Two Types of Maladaptive Coping Strategies as Mediators
Li, F., Liao, J., Liu, L., Yang, T., Dai, X., & Li, J. (2022) · Sexuality Research and Social Policy · doi:10.1007/s13178-022-00730-x · Cited by 5
The Impact of Social, Legal and Medical Transition on Psychological Distress for Transgender Persons
Luquet, W., Redcay, A., Counselman-Carpenter, E. A., & Gunn, J. (2025) · Advances in Social Work · doi:10.18060/27640 · Cited by 2
Protocol for a scoping review of PTSD and minority stress interventions for LGBTQIA + adults
Rosenfeld, E. A., Malek, N., Lockett, M., Edward, D., Hooper, V. S., Harper, K. L., Herbitter, C., Thompson, S., Ceja, A., Saty, M., et al. (2025) · Discover Psychology · doi:10.1007/s44202-025-00355-2 · Cited by 2
Nuancing the Relationship between Coming Out and Well-Being for Religious Sexual and Gender Minorities
Skidmore, S. J., & Lefevor, G. T. (2025) · International Journal for the Psychology of Religion · doi:10.1080/10508619.2025.2575225 · Cited by 2
“…et al., 2015, 2020; Legate et al., 2012; McDermott et al., 2019) or negative (e.g., Keating & Muller, 2020; Rosati et al., 2020; Ryan et al., 2009; Timmins et al., 2017) experience for religious SGMs. Part of the difficulty in discerning when coming out goes well or poorly is that most research…”
Psychiatric Authority and Gender Diversity in Mental Health Governance: Structural Vulnerability and Care Avoidance among Transgender and Gender Diverse Individuals with Psychiatric Diagnoses
Biton, N. (2026) · Sexuality Research and Social Policy · doi:10.1007/s13178-026-01339-0 · Cited by 2
Measuring Propensity to Perpetrate Microaggressions Toward LGBTQ Individuals: Sexual Orientation Microaggression Scale (SOMS-P) and Gender Identity Microaggression Scale (GIMS-P) Perpetration Version
Botor, N. J. B., & Tuliao, A. P. (2024) · Journal of Homosexuality · doi:10.1080/00918369.2024.2381525 · Cited by 2
“Various scales were developed to measure SOGI microaggression victimization experience (e.g., Swann et al., 2016; Timmins et al., 2017; Woodford, Chonody, et al., 2015; Woodford, Paceley, et al., 2015; Wright & Wegner, 2012; Nadal, 2019).”

Authors: Timmins, L., Rimes, K. A., & Rahman, Q.
Affiliations: King's College London (GB)
ORCID: Timmins, Liadh
Rimes, Katharine A.
Rahman, Qazi
Venue: Psychology of Sexual Orientation and Gender Diversity
Publisher: American Psychological Association (APA)
Published: 2017-09
Volume: 4
Issue: 3
Pages: 328-340
ISSN: 2329-0382 (ISSN-L)
2329-0390
DOI: 10.1037/sgd0000237
OpenAlex: W2737774863
Cited by: 131
References: 85
Citations by year: 2026: 8 · 2025: 21 · 2024: 13 · 2023: 11 · 2022: 19 · 2021: 20 · 2020: 22 · 2019: 9 · 2018: 8
FWCI: 15.31
Type: journal article
Language: en
Open access: closed
Locations: Psychology of Sexual Orientation and Gender Diversity (publishedVersion)
Cronfa (Swansea University) (acceptedVersion)
Research Portal (King's College London) (submittedVersion)
Topics: Social Sciences › Psychology › Social Psychology › LGBTQ Health, Identity, and Policy
Social Sciences › Sociology and Political Science › Racial and Ethnic Identity Research
Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Keywords: minority stress, transgender people, psychological distress, rumination, self-stigma

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Minority stressors and psychological distress in transgender individuals.

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